Posters

A case report of central toxic keratopathy (CTK) in a patient post transASLA with corneal collagen cross-linking (CXL)

Poster Details

First Author: N. Davey GREECE

Co Author(s):    I. Aslanides   V. Semilis   G. Kymionis              

Abstract Details

Purpose:

The purpose of this paper is to present a clinical case of CTK in the left eye of a patient post bilateral transASLA(transPRK) with CXL. To date CTK has not been reported in a refractive laser ablated eye post transASLA with CXL.

Setting:

A case report of 26yr old male that presented for laser refractive surgery at the Emmetropia Mediterranean Eye Institute in Heraklion, Crete, Greece. Bilateral aberration-free, transPRK laser (Schwind Amaris 750S) was performed for compound myopic astigmatism on 10 November 2015, followed by corneal collagen cross-linking (CXL).

Methods:

Case report. Preoperative details, Intraoperative ablation treatment, postop follow up including cornea pictures of the pathology, Orbscan and cornea OCT are documented. The pathology continues to be monitored and follow up pictures are to be included.

Results:

This may be the first documented report of a patient that developed CTK in a cornea post ASLA with CXL. CTK usually starts within 3 to 9 days after laser refractive surgery. The inciting procedure may be PRK, LASIK, or intra-LASIK. The opacity clears gradually, usually within 12 to 18 months. It is rare for the opacity to persist beyond 18 months. The etiology of CTK is still under contention, however, some of the previously proposed etiologies may be excluded from this case report.

Conclusions:

There is still uncertainty as to the optimal management of CTK as it is a rare entity with uncertain etiology. This may be the first case report of CTK occurring post transASLA with CXL. Unresolved blepharitis with bacteria, inflammatory cells, MMP and/or other proteolytic enzymes within the tear film perioperatively, contribute to the degradation of the vulnerable, exposed collagen(type IV) stromal tissue. The authors propose that special attention needs to be drawn to a healthy lid margin and tearfilm pre-ablation treatment, especially in contact lens wearers.

Financial Disclosure:

NONE